Provider Demographics
NPI:1760855902
Name:CHOI, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24840 ORCHARD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3054
Mailing Address - Country:US
Mailing Address - Phone:661-222-7881
Mailing Address - Fax:661-222-9114
Practice Address - Street 1:24840 ORCHARD VILLAGE RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-3054
Practice Address - Country:US
Practice Address - Phone:661-222-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH37678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist